AKV PUBLIC SCHOOL

Suriyagoundampalayam, Mallasamudram 63 !"3# $ama%%al &'#, (amil $adu# A))ilia'*d 'o CBS+, $*, &*l-i, A))#$o#./3"011

(2A$S3+2 C+2(I3ICA(+
Serial No. : Admission No. : EMIS No.
1. Name of the School : AKV PUBLIC SC !!L" SU#I$A%!UN&AMPALA$AM" MALLASAMU&#AM ' ()* +,)" NAMAKKAL -&t.. : NAMAKKAL : NAMAKKAL : 55555555555555555555.. : 55555555555555555555.. : 55555555555555555555..

/. Name of the Ed0cational &istrict ). Name of the #e1en0e &istrict 2. Name of the P03il -in Bloc4 Letters. +. Name of the 6ather (. Nationalit7 and #eli8ion 1. Comm0nit7 and Caste 9 :hether he9she ;elon8s to a. Adi &ra1idar -S.C. 9 S.<.. ;. Bac4:ard Class c. Most Bac4:ard Class

: 55555555555555555555.. : 55555555555555555555.. : 55555555555555555555..

d. Con1ert to Christianit7 from Sched0led Caste or : 55555555555555555555.. Sched0led <ri;e e. &enotified Comm0nities : 55555555555555555555..

If the 303il ;elon8s to an7 of the fi1e cate8ories mention a;o1e" :rite =$es> a8ainst the rele1ant item and also indicate the 3artic0lar comm0nit7 to :hich he 9 she ;elon8s. *. Se? @. &ate of Birth as entered in the Admission #e8ister -in fi80res and :ords. A. Personal Mar4s of Identification : a. ;. : 55555555555555555555.. : 55555555555555555555.. 55555555555555555555..

1,. &ate of Admission and standard in :hich the P03il :as admitted. -the 7ear to ;e entered in :ords. 11. Standard in :hich the 303il :as st0d7in8 at the time of lea1in8 - in :ords . 1/. Bhether C0alified for 3romotion to hi8her standard 1). Bhether the 303il has 3aid all the fees d0e to the school 12. Bhether the P03il :as in recei3t of an7 scholarshi3

: 55555555555555555555.. : 55555555555555555555.. : 55555555555555555555.. : 55555555555555555555.. : 55555555555555555555..

-Nat0re of the scholarshi3 to ;e s3ecified. 1+. Bhether the 303il has 0nder8one medical ins3ection d0rin8 the academic 7ear -6irst or re3eat to ;e s3ecified. 1(. &ate on :hich the 303il act0all7 left the school 1*. P03ilDs Cond0ct and Character 1@. &ate on :hich a33lication for transfer certificate :as made on ;ehalf of the 303il ;7 the 3arent or 80ardian 1A. &ate of <ransfer Certificate /,. Co0rse of St0d7 : 55555555555555555555..

: 55555555555555555555.. : 55555555555555555555.. : 55555555555555555555.. : 55555555555555555555..

Name of the School

AKV PUBLIC SC !!L" SU#I$A%!UN&AMPALA$AM" MALLASAMU&#AM ' ()* +,)" NAMAKKAL-&t..

Academic $ear-s.

Standard-s. st0died

6irst Lan80a8e

Medi0m of Instr0ction

EN%LIS

School seal

Si8nat0re of the Princi3al :ith date

Note : Eras0res and Una0thenticated or 6ra0d0lent alterations in the Certificate :ill lead to its
cancellation. Sho0ld ;e si8ned in in4 ;7 the head of the instit0tion" :ho :ill ;e held res3onsi;le for the correctness of the entries.

&ECLA#A<I!N B$ < E PA#EN< !# %UA#&IAN

I here;7 declare that the 3artic0lars recorded a8ainst items 1 to A are correct and no chan8e :ill ;e demanded ;7 me in f0t0re.

Si8nat0re of the st0dent

Si8nat0re of the Parent 9 %0ardian